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HIV-Associated Nephropathy

By

Frank O'Brien

, MD, Washington University in St. Louis

Last full review/revision Jul 2021| Content last modified Jul 2021
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HIV-associated nephropathy is characterized by clinical findings similar to those of focal segmental glomerulosclerosis and often biopsy features of collapsing glomerulopathy (a variant of focal segmental glomerulosclerosis).

HIV-associated nephropathy, a type of nephrotic syndrome Overview of Nephrotic Syndrome Nephrotic syndrome is urinary excretion of > 3 g of protein/day due to a glomerular disorder plus edema and hypoalbuminemia. It is more common among children and has both primary and secondary... read more , seems to be more common among black patients with HIV who are injection drug users or have been poorly compliant with antiretroviral therapy. Infection of renal cells with HIV may contribute.

Diagnosis

  • Renal biopsy

Ultrasonography, if done, shows that the kidneys are enlarged and highly echogenic.

Renal biopsy typically is done. Light microscopy shows capillary collapse of varying severity (collapsing glomerulopathy) and differing degrees of increased mesangial matrix. Tubular cells show marked degenerative changes and tubular atrophy or microcytic dilation. Interstitial immune cell infiltrate, fibrosis, and edema are common. Tubular reticular inclusions, similar to those in systemic lupus erythematosus Systemic Lupus Erythematosus (SLE) Systemic lupus erythematosus is a chronic, multisystem, inflammatory disorder of autoimmune etiology, occurring predominantly in young women. Common manifestations may include arthralgias and... read more Systemic Lupus Erythematosus (SLE) , are found within endothelial cells but are now rare with more effective HIV therapy.

Normotension and persistently enlarged kidneys help to differentiate HIV-associated nephropathy from focal segmental glomerulosclerosis.

Treatment

  • Highly active antiretroviral therapy (HAART) and angiotensin-converting enzyme (ACE) inhibitors

Control of the HIV infection may help minimize renal damage; in fact, HIV-associated nephropathy is rare in patients taking HAART with well-controlled HIV infection. ACE inhibitors are probably of some benefit. The role of corticosteroids is not well defined. At some centers, outcomes after kidney transplantation Kidney Transplantation Kidney transplantation is the most common type of solid organ transplantation. (See also Overview of Transplantation.) The primary indication for kidney transplantation is End-stage renal failure... read more have been excellent.

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